This is a 70s year-old man who was found to have MSSA bacteremia with septic shock and endocarditis. He had vegetations on the anterior and posterior leaflets of the mitral valve. MRI Brain demonstrated numerous bilateral supra- and infra-tentorial infarcts.

Diagnostic cerebral angiography demonstrated a small (<1mm) cortical mycotic aneurysm in the left MCA/ACA watershed region.

Mycotic aneurysms are frequently found in the periphery and are often found in watershed regions.

Cardiac surgery was deferred given underlying liver disease and concern for surgical complications. The patient was treated with 6 weeks of Cefazolin and did well without intervention.